AccountId: 011433970860
ContactId: db891d0a-8928-4aa6-b6ff-f73d3b957bd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281140 ms
Total Talk Time (AGENT): 117471 ms
Total Talk Time (CUSTOMER): 124919 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/db891d0a-8928-4aa6-b6ff-f73d3b957bd8_20250321T20:17_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEGATIVE] Yeah, I'm calling about a claim I filed uh earlier this week it wasn't paid.
[AGENT][NEUTRAL] Yes, sir. I can assist you with claim status. First, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you and a good callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] OK 1 2nd.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Group number?
[AGENT][NEUTRAL] Um, the policy number, it should be the outpatient certificate number.
[CUSTOMER][NEUTRAL] On the card?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 022846
[CUSTOMER][NEUTRAL] 40 ML 8
[AGENT][NEUTRAL] OK. Thank you. Now, please verify your name again and your date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII], [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And now, please verify your email address and your home address.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] And my home address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And the claim you're calling about, is it for you or one of your dependents?
[CUSTOMER][NEUTRAL] It's for my son [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And do you either have a claim number or the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, you know what, I just lost the Internet. I had this the web page open. It was the most recent claim. I filed it on the [PII].
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I just I literally just had the.
[AGENT][NEUTRAL] Was it for an ER visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yes, sir. I'm showing that that claim denied because we need the diagnosis code and you can get the diagnosis code from the ER once you get that information, um, just write the claim number on it and send it to us the way that you sent the claim, and we should be able to get it reprocessed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, can you see the attachments that I put in there because they, they did have codes. I don't know if they're diagnosis or something else, but they had a code for each item.
[AGENT][NEUTRAL] Yes, sir. Those are procedure codes and what we're looking for is the diagnosis code. The diagnosis code is the code for the illness. The reason why he went to the ER we um have to see that to verify that the cervix is for an illness or an injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then when I get those codes, do I reattach it to the current claim or do I have to file a new claim?
[AGENT][NEUTRAL] Um, you can reattach it to the current claim, so there's no confusion and also write the claim number on there and I can give you the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'll take it.
[AGENT][NEUTRAL] Just let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Um, the claim number is 357-847-9.
[CUSTOMER][NEUTRAL] 8479 and then do I have to notify you guys to to look at it again or do you see that it's been updated?
[AGENT][NEUTRAL] Um, you can just make a little note saying that this is additional documentation for this claim, but if, if you forget, yeah, we'll see that um it's all for the same claim, so, and we'll get that reprocessed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] OK, sounds good I'll give them a call.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] OK, well, I
[CUSTOMER][NEUTRAL] Oh, I guess, um, yeah, I did have a, I'm sorry, I did have a question, so this.
[CUSTOMER][NEUTRAL] Um, this was from [PII] and we did not get a bill until December, but he was covered.
[CUSTOMER][NEUTRAL] With the same policy at that time, so I'm hoping I'm, I'm thinking that I I can still file this is that it's within the.
[CUSTOMER][NEUTRAL] The grace period, right?
[AGENT][NEUTRAL] Right, actually, under this policy, there is no timely filing limit, so as long as there was coverage on the date of service, we can get the claim processed.
[CUSTOMER][POSITIVE] Perfect. OK, thanks for your help.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great weekend. Mm bye.
[CUSTOMER][POSITIVE] Thank you you too bye